Provider Demographics
NPI:1619190998
Name:STATE OF ALABAMA DEPT OF MENTAL HEALTH & MENTAL RETARDATION
Entity Type:Organization
Organization Name:STATE OF ALABAMA DEPT OF MENTAL HEALTH & MENTAL RETARDATION
Other - Org Name:GREIL MEMORIAL PSYCHIATRIC HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-262-0363
Mailing Address - Street 1:2140 UPPER WETUMPKA ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107
Mailing Address - Country:US
Mailing Address - Phone:334-262-0363
Mailing Address - Fax:334-834-4562
Practice Address - Street 1:2140 UPPER WETUMPKA ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107
Practice Address - Country:US
Practice Address - Phone:334-262-0363
Practice Address - Fax:334-834-4562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF839Medicare PIN
AL01-4005Medicare Oscar/Certification